HIPAAHIPAATRANSACTIONSTRANSACTIONS

2002 UPDATE2002 UPDATE

HHS Office of General Counsel

Donna Eden Office of the General Counsel Department of Health and Human Services

HHS Office of General Counsel

The information and views in this presentation do not represent official views of the U.S. Department of Health and Human Services

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TransactionsTransactions

In implementation, finally Process for modifications in place Code sets

– Sets missing

– Codes missing

– Local codes consolidation HIPAA Web Site transition

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Transaction/Code Sets Transaction/Code Sets TimetableTimetable

Final Regulation published in August, 2000 Original compliance date: October 16, 2002 Many sectors of health care requested

additional time to build, test, and successfully implement the standards

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Congress’ ResponseCongress’ Response

Administrative Simplification Compliance Act (ASCA)

Signed into law by President Bush on December 27, 2001 as Public Law 107-105

Allows covered entities to request a one-year extension for transactions compliance

Does not affect other HIPAA standards

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ASCA ProvisionsASCA Provisions

Directed to covered entities with October 16, 2003 compliance date for full implementation of Transactions Rule

IF compliance extension plan submitted to HHS by 10/15/2002

THEN compliance date is extended to 10/16/2003

Model FormModel Form

HHS to publish a model compliance extension form by March 31, 2002

Model form or another format File electronically or via paper No funds appropriated, but $44.2 million

authorized -- decreases if HHS misses March 31 deadline

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Small Health Plans Small Health Plans

Small health plans currently have a compliance date of October 16, 2003

No further extension for small plans What is “small”?

– Providers with fewer than 25 FTEs

– Practitioners et al. with fewer than 10 FTEs

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Compliance Extension Form:Compliance Extension Form:Required ElementsRequired Elements

Reasons for non-compliance Schedule for transaction implementation Work plan and budget Implementation strategy Planned use of contractors or vendors Time frame for testing, starting no later

than April 16, 2003

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Compliance Plan FormCompliance Plan FormInstructionsInstructions

Summary information only No space for information protected as

– Trade secrets or proprietary information

– Personal information Agents may submit form on behalf of

covered entities

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Congressional PurposesCongressional Purposes

Completion of extension plans

– requires covered entities to develop a plan for compliance

– provides useful data to NCVHS Not to add new burdens on covered entities

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Extension Based on Extension Based on Submission of FormSubmission of Form

No separate review Proof of extension from receipt

– electronic, automatic if submitted electronically

– U.S. Mail or other service

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National Committee on Vital National Committee on Vital and Health Statistics and Health Statistics

Sample of compliance extension plans to be provided to NCVHS

NCVHS will

– identify common barriers to compliance activities

– publish recommendations for solving the problems

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Developing the Model FormDeveloping the Model Form

Workgroup for Electronic Data Interchange (WEDI) convened industry group to draft a model compliance extension form, which they have recommended to the Secretary.

Providers, plans, and vendor organizations all included in group

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NCVHS HearingNCVHS Hearing

Hearing on February 7, 2002 Reviewed form, heard comments General consensus: KISS principle Subcommittee in general agreement

with form

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NHVHS ConcernsNHVHS Concerns

Promote use of model form via web Address provider concerns about

disclosure of proprietary information

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ASCA: Medicare ExclusionsASCA: Medicare Exclusions

Secretary may exclude providers from participating in Medicare after October 16, 2002 if :

– no compliance extension form submitted

– not compliant by October 16, 2002 HHS will initiate rulemaking

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ASCA: Medicare ClaimsASCA: Medicare Claims After October 16, 2003 Medicare may no

longer pay paper claims Exceptions:

– No method for electronic submission

– Small providers of services or suppliesProvider with less than 25 FTEsPractitioner, et al., less than 10 FTEs

– Unusual circumstances

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Future ActionsFuture Actions

First Transactions modifications

– Corrections

– Changes based on SDO reviews and DSMO process

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Final HIPAA RegulationsFinal HIPAA RegulationsTo ComeTo Come

National Provider Identifier Employer Identifier Security Electronic Signature

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Proposed HIPAA Rules Proposed HIPAA Rules To ComeTo Come

Privacy modifications National Plan Identifier Claims Attachments Annual modifications

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Covered Entity To Do List Covered Entity To Do List

Monitor CMS web site for form Submit form if extension desired Work with IT staff and vendors Contact your trading partners Join WEDI/SNIP efforts Support SDOs Use the delay time to reach compliance

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Web SitesWeb Sites

Transactions and code sets

– www.cms.gov Washington Publishing Co.

– http://www.wpc-edi.com National Committee on Vital and Health

Statistics:

– http://aspe.hhs.gov/ncvhs/

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More ResourcesMore Resources

Workgroup on Electronic Data Interchange:

– http://wedi.org WEDI/Strategic National Implementation

Process:

– http://snip.wedi.org Privacy:

– http://www.hhs.gov/ocr/hipaa/